Provider Demographics
NPI:1831310218
Name:DENT, MICHAEL FREDERICK (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:DENT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-5232
Mailing Address - Country:US
Mailing Address - Phone:229-567-3631
Mailing Address - Fax:
Practice Address - Street 1:372 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-5232
Practice Address - Country:US
Practice Address - Phone:229-567-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA112811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice